Hospital Medicine Update: High-Impact Literature from March 2018 to April 2019

Area of Science:

• Hospital Medicine
• Clinical Practice Guidelines
• Evidence-Based Medicine

Background:

• Busy hospital medicine clinicians require concise summaries of recent impactful research.
• A review of articles presented at the Society of Hospital Medicine and Society of General Internal Medicine Annual Meetings was conducted.
• Ten articles were selected based on quality and clinical impact for this summary.

Purpose of the Study:

• To summarize 10 high-impact clinical articles relevant to hospital medicine.
• To provide actionable insights for improving patient care and outcomes.
• To distill complex research into easily digestible findings for clinicians.

Main Methods:

• A literature review of articles published between March 2018 and April 2019.
• Selection of 30 presented articles for further review.
• Author voting to identify the top 10 articles based on clinical impact and quality.

Main Results:

• First-line treatment for Clostridioides difficile infection: vancomycin or fidaxomicin.
• Target oxygen saturation of 90%-94% recommended; unnecessary oxygen linked to increased mortality.
• Consider ablation for atrial fibrillation in heart failure patients; offer buprenorphine/methadone for opioid use disorder.
• Apixaban may be preferable to warfarin in atrial fibrillation with end-stage kidney disease.
• Discontinue MRSA coverage for improving hospital-acquired pneumonia with negative cultures.
• Switch selected left-sided endocarditis patients (excl. MRSA) to oral antibiotics after 10 IV days if stable.
• Oral antibiotics may be equivalent to IV for joint and soft tissue infections.
• HEART score ≥4 identifies patients at risk for short-term major adverse cardiac events.

Conclusions:

• These findings offer practical guidance for managing common and critical conditions in hospital medicine.
• Evidence supports optimizing oxygen therapy, antibiotic stewardship, and cardiovascular disease management.
• The summary emphasizes patient-centered care, including addressing opioid use disorder and utilizing validated risk scores.